Provider First Line Business Practice Location Address:
409 E PRAIRIE VIEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHIPPEWA FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54729-3464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-726-1831
Provider Business Practice Location Address Fax Number:
715-726-0187
Provider Enumeration Date:
02/19/2010